Category Archives: Emergency Preparedness and Response
An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?
Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble. We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.
And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.
HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?
Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.
The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.
The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.
This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely.
Olivia Jackson is an alumna of the Robert Wood Johnson Foundation’s New Careers in Nursing (NCIN) program. She graduated summa cum laude from Fairleigh Dickinson University's Accelerated Bachelor's Degree in Nursing program this past May. She has a BA in Biological Sciences from Rutgers University. She is currently pursuing a career in medical surgical nursing.
The Jersey Shore is open for business this summer, and I am proud to say that I played a small part if making that happen, and helping the community that was devastated by Hurricane Sandy last year.
In October 2012, Hurricane Sandy wreaked havoc on the East Coast, especially in New Jersey and New York. For our November volunteer project, I and several other NCIN scholars at Fairleigh Dickinson University devoted a Saturday to helping the citizens of Rockaway Beach, New York, where the storm was particularly strong.
Through online research on Newyorkcares.org, I located a bus going to the Rockaways that needed more volunteers to help assemble and distribute care packages to the people affected by Hurricane Sandy. As our bus pulled into the Rockaways, the first thing we saw is what used to be a parking lot for beachgoers. It looked like a scene from an apocalyptic movie. Mounds of debris, most of which used to be the homes of Rockaway residents, extended across the horizon. I felt a deep sense of sadness and could not even imagine how devastated these people must feel having lost everything.
During the week of April 15, the United States faced several natural and man-made disasters: the Boston Marathon bombings, an explosion at a Texas fertilizer plant, and ricin-laced letters mailed to politicians. Federal and local officials—including Nicole Lurie, MD, MSPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1982-1984) and assistant secretary for preparedness and response at the U.S. Department of Health and Human Services—were ready, and quickly responded to these events.
In the second video in a series of RWJF Clinical Scholars Health Policy Podcasts, Clinical Scholar Chileshe Nkonde-Price, MD, interviews Lurie about that week and the state of the country’s disaster preparedness. They also explore the impact of budget cuts on public health jobs, and what aspects of disaster response are ripe for scholarly study.
The video is republished with permission from the Leonard Davis Institute.
Carolyn Hayes, PhD, RN, NEA-BC, is associate chief nurse for Adult Inpatient and Integrative Oncology at Dana-Farber Cancer Institute and Brigham & Women’s Hospital (BWH) in Boston, MA. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2012). Here, Hayes reflects on how nurses provided quality care to patients and others traumatized by the bombing at the Boston Marathon. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
I remember a brief report on television, just after the Newtown shootings, when an emergency department (ED) physician in Connecticut said his emotional pain started with his realization that his ED was not getting any victims. It clearly overwhelmed him not to be able to help. At the time I felt for him but on Monday, April 15, after the Boston Marathon bombing, I truly understood him. I, along with other highly-skilled members of the health care and support teams at Brigham & Women’s Hospital, had the privilege of making a difference for the victims of that tragic event.
That Monday, I was the operations section chief—the role designed to ensure staff, materials, supplies, and systems are in place to address whatever is occurring. On Friday the 19th, the day that Boston and surrounding towns were instructed to “shelter in place,” I was incident commander.
We saved lives and limbs in our ED that day. But we also tended to the anxiety, fear, and confusion created by an attack on our city. We addressed with patients, their families, family members of unidentified marathon victims, and ourselves, the existential gap created by the “why” of it all. We lived out what we had trained for, yet couldn’t comprehend. And we did it all as a community.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research and trends relating to academic progression, leadership and other critically important nursing issues. Here are descriptions of some of the stories in the December issue:
In the weeks after Hurricane Sandy pummeled shores in New York and New Jersey, a number of stories surfaced about the critical role nurses played during and after the storm hit. Nurses are gaining widespread recognition for their emergency-relief work—even a nod from President Obama. But the contributions of nurses working as emergency responders is not new. Read the story.
CDC Recognizes Nurse Leader for Groundbreaking Research on Domestic Violence
RWJF Nurse Faculty Scholar program director Jacquelyn Campbell is being hailed as one of the 20 most influential researchers in injury prevention over the last 20 years by the Centers for Disease Control and Prevention (CDC). Campbell’s groundbreaking research has shown that nurses can work alongside partners in health care, law enforcement and social work to protect women from the ravages of domestic violence. The school nurse turned domestic violence prevention pioneer is the only nurse to receive the CDC’s prestigious distinction. Read the profile.
Signs of Progress in Addressing New Jersey’s Nurse Faculty Shortage
Legislators had praise and questions for the health, business and academic leaders who gathered at the State House in Trenton on Nov. 19 to provide updates on progress made so far by the New Jersey Nursing Initiative (NJNI)—a multi-year, multi-million-dollar project of RWJF and the New Jersey Chamber of Commerce Foundation that is working to fill nurse faculty positions in the state. Since its inception in 2009, NJNI’s Faculty Preparation Program has supported 61 New Jersey Nursing Scholars who are pursuing (or have completed) master’s or doctoral degrees that qualify them for nurse faculty positions. Read the story.
Why Nurses Go Back to School
A new study from the RWJF RN Work Project identifies the characteristics and factors that best predict whether nurses will return to school to earn higher degrees. The researchers identified internal and external motivators, and barriers, to advancing nurses’ education. Learn more.
Raina Merchant, MD, MSHP, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumna and an assistant professor at the University of Pennsylvania Department of Emergency Medicine. She recently led the MyHeartMap Challenge, a community improvement initiative and research project to identify and map automated external defibrillators (AEDs) in Philadelphia. Read a post she wrote for the RWJF Human Capital Blog about the Challenge.
Human Capital Blog: Why was it important to collect information about the location of AEDs?
Raina Merchant: Currently there is no comprehensive map or database of where all the AEDs are located—in Philadelphia or really anywhere. So when someone collapses, we have to rely on people remembering where they last saw an AED. In fact, most 911 centers don’t have databases of where AEDs are located. So, the likelihood of being able to find one in an emergency is pretty low, and as a result we have these lifesaving devices that are rarely used. We used the MyHeartMap Challenge, an innovation tournament to have the public find AEDs in Philadelphia, take a photo using a smartphone app, and tag their location so we can make this information available to anyone who needs it.
HCB: How many people or teams participated in the Challenge? How many AEDs were identified?
Merchant: We were really excited about the results. We had more than 330 participants (individuals and teams) who contributed data to the Challenge. They reported more than 1,500 locations of AEDs in the city of Philadelphia. We’re still trying to sort out who exactly participated, but we had representation from schools and health organizations, as well as a lot of individuals who recruited their friends, neighbors and colleagues. We were worried that people would make up devices, submit false locations or send low-quality pictures, but we were really impressed with the quality of data we received. Every one took this challenge very seriously. The challenge had two winners who were each awarded $9,000 for reporting more than 430 AEDs each. Both winners were also over the age of 40.
By Raina Merchant, MD, MSHP, Robert Wood Johnson Foundation Clinical Scholars program alumna and assistant professor, University of Pennsylvania Department of Emergency Medicine
If the person next to you went into cardiac arrest, would you know what to do? Would you know where to find an automated external defibrillator (AED) to shock and restart their heart? Millions of public places across the United States have AEDs that can save lives – airports, casinos, churches, gyms and schools, among them – but most people don’t know where they’re located. Every second counts when someone’s heart stops beating, and time spent searching for an AED is time wasted in increasing the chances of survival.
Surprisingly, no one knows where all of the country’s AEDs are located. Requirements for AED reporting and registration vary widely by state, and no comprehensive map of their locations has ever been compiled. As a result, 911 dispatchers aren’t always able to direct callers to an AED in an emergency, and callers have no good way of quickly locating one on their own.
This week, I launched the MyHeartMap Challenge with a multidisciplinary team from the University of Pennsylvania. This pilot study will use social media and social networking tools to gather this critical public health data and create searchable maps of Philadelphia’s AEDs that can be used by health professionals and the general public.
The first step of our challenge is a Philadelphia-based community-wide contest. We’re asking Philadelphians to find and photograph AEDs over the next six weeks, and submit the photo and location to us via a mobile app or our website. You can also participate if you don’t live in Philadelphia by finding a creative way to use your social network or harness crowdsourcing.
Sidney Coupet, DO, MPH, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan, is the founder and executive director of Doctors United for Haiti. Read more about his work on the RWJF Human Capital website.
Did you know the average Haitian physician sees about 100 patients a day? Can you imagine if your doctor had to see 100 patients a day? Trust me, remembering your name would be the least of her problems! In a country with rampant chronic and infectious diseases, the poor health state – and an ambiguous health care system – can be overwhelming for Haitian health care professionals. Many of them leave the country in hopes of a better career and life.
But simultaneously, an overwhelming number of U.S. physicians are traveling to the shores of Haiti. They’re providing humanitarian aid and lifting a burden, intervening before Haitian health care professionals decide to flee their own country.
And they’re doing it through Doctors United For Haiti, an organization I started in 2006 to help my parents’ native country.
Doctors United For Haiti (DUFH) has created an academic environment in which both American and Haitian health care professionals benefit. Our program creates an opportunity for doctors, nurses, allied health professionals, mental health professionals and health administrators to share and exchange knowledge in a non-threatening environment. This academic approach was created as an opportunity to empower, educate and support Haitian health care professionals as they deliver quality care to their own people.
Simultaneously, it provides opportunities for American health care professionals to receive global health training. While this model is obviously providing opportunities for improvement in Haiti, our doctors will return with skills that will save our own system money and make it run more efficiently.
Sharon Stanley, PhD, RN, a new Robert Wood Johnson Foundation Executive Nurse Fellow, the chief nurse for the American Red Cross, and a recently retired leader in the U.S. Army Reserves after 34 years of service, discusses the role nurses can play in disaster relief.
Human Capital Blog: Congratulations on your selection for the Executive Nurse Fellows (ENF) program. The news broke amidst earthquakes and hurricanes – not your easy season! But your work with the Red Cross is related to your plans for the fellowship. Tell us about that, please.
Sharon Stanley: It’s absolutely related. What I’d like to focus on with the fellowship is the role of nurses in disaster planning and relief at the American Red Cross. So it’s very timely! We rely greatly on nurses in disaster recovery. They’re really the “care” component of what we do. But it’s not just after the disaster strikes where nurses need to play a role. Our preparedness efforts go on all year, across the organization. We’re working to educate our various communities and lay the foundation for preparedness and recovery. Nurses are already involved in that, and I’m hoping that as a result of my work with the ENF program they’ll become even more fully integrated and take a bigger role in the leadership of our efforts.
One thing we’re doing already to help accomplish that is the addition of a new volunteer component to disaster response – the certified nursing assistant (CNA). Red Cross has been providing nurse assistant training for a while now. In disaster situations, when people are displaced, it’s important to have trained volunteers who can help care for people who live with access and functional needs at shelters. Those needs don’t go away in a disaster; if anything, those needs become more acute in such circumstances, in the midst of the chaos. So we’re ramping up our training for CNAs and, of course, that training is of use to the community not just in disaster circumstances or even just in preparation for disaster, but all year round.
HCB: Give us a sense of how you prepare for disasters.
Stanley: I think one of the biggest misconceptions about our work is that we pop up when hurricanes roll into town and then recede when the storm passes. In fact, we’re very busy making sure that needed resources are both available and in place before the storm hits, and we’re still there long after the winds stop blowing or the ground stops shaking.